Surgical wound-healing complications in heart transplant recipients treated with rapamycin

The aim of this retrospective analysis was to assess the influence of rapamycin (RAPA) used perioperatively on surgical complications in heart transplant recipients. The study group consisted of 28 heart transplant recipients (26M/2F, 49.2 +/- 11 years) receiving 15mg of RAPA before operation, 10mg of RAPA on the first postoperative day (POD) and 5mg daily (n=20) thereafter, or 5mg daily starting on POD 2 (n=8), until the introduction of cyclosporine-A. A matched historical control group was composed of 28 patients (26M/2F, 49.7 +/- 9 years) receiving cyclosporine-A from POD 1. We compared a number of surgical complications and reinterventions among groups. Statistical significance was assessed using the chi-square test and the Mann-Whitney U-test. There were 16 (57%) patients in the study group vs. six (21%) in the control group requiring reintervention (p=0.014). Pericardial tamponade decompression was performed in seven (25%) vs. zero patients, and sternum refixation in seven (25%) vs. zero patients (p=0.015). None of the wounds was infected. The overall drainage volume was 4,213 +/- 5,996 vs. 1,911 +/- 1,728 mL (p=NS). The frequencies of biopsy-proven rejection and infection were comparable, except lower cytomegalovirus infection rates in the study group: three (11%) vs. 11 (39%) for the control group (p=0.023). The use of RAPA in the perioperative period of heart transplantation increases the risk of surgical wound-healing complications.